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2015 ; 94
(50
): e2044
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A Review of GM-CSF Therapy in Sepsis
#MMPMID26683913
Mathias B
; Szpila BE
; Moore FA
; Efron PA
; Moldawer LL
Medicine (Baltimore)
2015[Dec]; 94
(50
): e2044
PMID26683913
show ga
Determine what clinical role, if any, GM-CSF may have in the clinical treatment
of sepsis in the adult patient. Advancements in the management of sepsis have led
to significant decreases in early mortality; however, sepsis remains a
significant source of long-term mortality and disability which places strain on
healthcare resources with a substantial growing economic impact. Historically,
early multiple organ failure (MOF) and death in patients with severe sepsis was
thought to result from an exaggerated proinflammatory response called the
systemic inflammatory response syndrome (SIRS). Numerous prospective randomized
controlled trials (PRCTs) tested therapies aimed at decreasing the organ injury
associated with an exaggerated inflammatory response. With few exceptions, the
results from these PRCTs have been disappointing, and currently no specific
therapeutic agent is approved to counteract the early SIRS response in patients
with severe sepsis. It has long been recognized that there is a delayed
immunosuppressive state that contributes to long-term morbidity. However, recent
findings now support a concurrent proinflammatory and anti-inflammatory response
present throughout sepsis. Multiple immunomodulating agents have been studied to
combat the immunosuppressive phase of sepsis with the goal of decreasing
secondary infection, reducing organ dysfunction, decreasing ICU stays, and
improving survival. Granulocyte-macrophage colony stimulating factor (GM-CSF), a
myelopoietic growth factor currently used in patients with neutropenia secondary
to chemotherapy-induced myelosuppression, has been studied as a potential
immune-activating agent. The applicability of GM-CSF as a standard therapy for
generalized sepsis is still largely understudied; however, small-scale studies
available have demonstrated some improved recovery from infection, decreased
hospital length of stay, decreased days requiring mechanical ventilation, and
decreased medical costs.
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Animals
[MESH]
|Biomarkers
[MESH]
|Critical Illness
[MESH]
|Granulocyte-Macrophage Colony-Stimulating Factor/*therapeutic use
[MESH]
free
free
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